Atypical wounds: diagnosis and management
Marco Romanelli, MD PhD
Professor and Chairman
Dept. of Dermatology, University of Pisa
New treatments for chronic wounds have led to improvements in lesion management and in the quality of assistance provided by medical and paramedical staff, but lesion monitoring methodologies have not kept pace with this progress.
The constant improvement of diagnostic and therapeutic procedures, together with the increase of life lasting, results in a higher frequency of patients suffering from chronic cutaneous ulcers.
Due to the high costs these pathologies imply for treatments and often poor outcomes in terms of quality of life, a decrease in patients’ hospitalization, without a corresponding worsening of the quality of therapy, would provide important benefit.
Moreover, since the healing process is remarkably slow, the clinical perception of the phases that lead a chronic wound to complete restoration is often penalized: this effect is dramatically amplified in those cases in which the patient is followed by more than one operator.
Therefore, the study of wound healing pathophysiology and the development of new tools for the monitoring of the healing process may represent a possible optimization of the treatment efficacy for these lesions.
The morphologic features of an ulcerative cutaneous lesion can be substantially analyzed according to two distinguished modalities: the quantification of the loss of substance such as the extension and depth of the lesion, characteristics of the edges, and the qualitative discrimination of the several areas of the wound bed like the presence of necrosis, fibrin, fluid, extension of the surrounding skin inflammation. Molecular and histologic analysis of chronic wounds have been suggested as a method to validate the use of debridement. The non healing edge contains cells with molecular markers indicative of healing impairment. The use of wound and skin biomarkers will provide substantial informations in the near future to better understand the non healing wounds process.